EXHIBIT B CONTRACTOR EVALUATION FORM.docx
DOCX document 27 KB Posted
- Attached to
- AMMENDMENT 002_36C25623R0101_PROJ 564-18-105_REPLACE WINDOWS AND DOORS B4, B5, B6, AND B7- Solicitation
- Solicitation number
- 36C25623R0101_REPLACE_WINDOWS_DOORS_B4_B5_B6_AND_B7
About this file
This document contains a contractor evaluation form and details of a related federal contract opportunity. The evaluation form requests safety-related information from contractors, including man-hours, OSHA recordable incidents, violation details, and insurance rates. Eligible contractors must submit the requested safety records and documents.
The related federal contract opportunity is a solicitation from the Department of Veterans Affairs to replace windows and doors at several buildings. Offerors would be evaluated based on the safety criteria in the attached contractor evaluation form. The solicitation provides an opportunity for contractors to compete to provide window and door replacement services at Veterans Affairs facilities.
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| RFI_564-18-105_36C25623R0101.xlsx | XLSX spreadsheet | |
| 564-18-105_Amendment 01_36C25623R0101_08092023.pdf | ||
| P01_UPDATED SPECS 07102023.pdf | ||
| P07_WD_AR20220035_06222023.pdf | ||
| SOLICITATION-DESCRIPTION.docx | DOCX document | |
| S02_SOLICITATION_36C25623R0101_07132023.pdf | ||
| EXHIBIT A PERFORMANCE RELEVANCY SURVEY.docx | DOCX document | |
| P01_UPDATED DRAWINGS 07102023.pdf | ||
| P09_564-18-105_FINAL SOW.pdf |
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Text version
FOR OFFICIAL USE ONLY
Exhibit B Contractor Evaluation Form Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanations for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms.
These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
| 2. | Who administers your company’s Safety and Health Program? |
| 3. | Company’s current Insurance Experience Modification Rate (EMR): |
The above EMR rate must be obtained from offeror’s insurance carrier and furnished on insurance carrier’s letterhead. If EMR is greater than 1.0, attach a written explanation of the EMR from insurance carrier on insurance carrier’s letterhead describing the reasons for the EMR and the anticipated date the EMR may be reduced to 1.0 or below.
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